My last two posts were prompted by the campaign launched in the Daily Mail to get the Government to address the disgraceful state of care for people with dementia in this country. It has very successfully exposed the level of outrage and injustice felt by relatives, but the focus has been on the high cost of care and the consequent loss of the family home to pay for the care. This, maybe incorrectly, can be interpreted as a desire by the relatives to hang to their inheritance.
My last post illustrates that the issues with dementia are much wider than that and require a radical and comprehensive approach to all the issues, not just a political quick fix. There are no simple or quick solutions and the answers will require financial contributions from the Government and individual sufferers.
HERE IS MY TEN POINT TEN YEAR PLAN ——————-—-it will take that long to transform the scale of the problems, but action should start right away :-
1. FOCUS NHS HEALTH SUPPORT ON BETTER DIAGNOSIS AND PREVENTION.
Better diagnostic consideration will eliminate confused older people who are wrongly assumed to have dementia, when they may have something that is easily treated, such as a urinary infection. The other main role for the NHS / GP service should be on prevention through targeted advice and support regarding risk factors e.g.:- obesity / exercise / diet / smoking. In support terms improved free Audiology services have been shown to reduce isolation.
2. TRANSFER NHS FUNDS TO SOCIAL SERVICES ON CONDITION THEY EMPTY BLOCKED BEDS IN THE NHS.
A great many NHS hospital beds are “blocked” by elderly patients with dementia awaiting a discharge, either into residential care or to their own with domicillary care support in the community. The cost of keeping them in hospital is far higher than sending them home or to Residential Care, but the financial responsibility is an invisible wall which creates an impasse to sensible action.
The Government needs to grasp the nettle and transfer the money to Social Services.
3. GRANT FUND A TEN YEAR PROGRAMME OF RETIREMENT HOUSING.
There needs to be much more retirement housing to give older people a range of options to downsize and release equity to pay for better support in later life. The options need to include shared ownership as well as outright sale and also Social rented accommodation for those who can’t afford to purchase their home. Also there needs to be the opportunity to release more equity to pay for care as it is needed, using the mechanism of staircasing down by selling back more equity.
In almost every case this will release back onto to the market a much needed family home. Ten million new retirement homes in ten years would be a good start !
This type of housing is only suitable for people with dementia if the support staff are specially trained e.g. the “locksmith”in the ExtraCare Charitable Trust’s retirement villages.
4. REINVIGORATE SPECIALIST RESIDENTIAL NURSING CARE.
Most Residential Care Homes have become warehouses for people with dementia. Staff are largely untrained and poorly paid. Many of the residents are over medicated to make them easier to look after. There is little by way of stimulating activity. It has become an “out of sight, out of mind” solution.
All this needs to change, starting with a nursing managed service. Less use of drugs and individualised care. Properly and equitably charged for between private and public payers, by having the same charges for everyone. But, there also needs to be greater control on the use of “vulture capital”, which is creating excessive fees.
5. MASSIVELY EXPAND HOME CARE SERVICES.
Most people who need care would prefer to remain in their own homes. With a little support for the sufferer and their carers this is eminently possible. The support needs to be available early in the process and offer respite to carers who are often family members.
6. LAUNCH A NEW DEMENTIA NURSING QUALIFICATION.
Training in the sector should be boosted with a new work-experience based nursing qualification for careers specialising in dementia. It should command higher salaries and be a mandatory requirement for 80% of all staff working in Residential Homes and Domicillary Care.
7. MOBILISE THE VOLUNTARY SECTOR WITH A DEMENTIA GRANTS FUND.
There will never be enough paid staff to support informal care in the community and therefore help will be required from the voluntary sector. Several years ago the Alzheimer’s Society called for a million volunteers, so far they say they have 350,000. They need seed funding to achieve the target, so they can provide befriending visits / welfare advice / social clubs and more to anyone who might benefit from them. Combating isolation should be a priority in the fight against dementia.
8. DE-RISK THE LONG-TERM CARE INSURANCE INDUSTRY TO STIMULATE NEW PRODUCTS.
The Dilnot Commission had a core ambition of stimulating new long-term care insurance products, but its recommendations were never taken up. These should be revisited and de-risked to make them cheaper to the consumer and more predictable to the insurance industry. This would probably require a tax free mandatory scheme with a “stop loss” clause underwritten by the Government.
9. LAUNCH A BETTER REGULATED AND CHEAPER EQUITY RELEASE OFFER.
Equity release is expensive and comes with onerous conditions. However, it may be the only way to unlock equity in your house if you wish to remain in your home and require money to pay for care. The Government could agree to provide a “cap” on costs in exchange for lower interests charges.
10. DOUBLE THE RESEARCH PROGRAMME ON THE CAUSES OF DEMENTIA.
The overall cost of dementia to the Country is enormous and still rising rapidly. Though all the above measures will help, they will add even more to the costs, therefore it makes sense to invest in research to try and find better treatments and hopefully in due course a cure for all dementia related conditions.
I DO NOT PRETEND THESE RECOMMENDATIONS ARE ALL MY OWN WORK, FAR FROM IT. THEY ARE DRAWN FROM OVER THIRTY YEARS WORKING WITH SOME EXCELLENT STAFF AND A GREAT MANY ELDERLY RESIDENTS. MY THANKS GO TO THEM ALL.